Ectopic Pregnancy 562gh

OBSTETRIC EMERGENCIES FIRST – TRIMESTER PREGNANCY EMERGENCIES

BY WAGIYO,Skp.,M.Kep

ECTOPIC PREGNANCY I.

Definition 1. Ectopic pregnancy occur when the fertilized ovum implantation enywhere other then in the endometrium of the uterine cavity. 2. Such as in the fallopian tube, the ovary, the cervix or the abdominal cavity and begins to grow and possibly rupture

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Rupture usuallty occurs after the twelfth week of pregnancy. Ninety – five percent of all ectopic pregnancy involve of the falopian tubes. Ectopic pregnancy is one of the major causes of the maternal death because involves the rupture of a highly vascularized area. Death is usually the result of the hemorrhage. Women with rupture ectopic pregnancies are often see in the emergencie department.

PREDISPOSING FACTORS   

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Tubel infections Adesions from previous surgery Tubal ligations Possibly the presence of the intrauterine devices. The most common site for tubal implatations is the ampulla, followed by the isthmus. Ektopic pregnency is condition that may Confuse the best diagnostician.

BEING THE GREET IMITATOR IT MAY BE MISTAKEN.  For

a ruptured ovarian cyst.  Appenducitis.  Pelvic imflamatori disease (PID).  Incomplete abortion.  Pelvic pain and vaginal bleeding.  Kehr’s sign –radiating shoulder pain that occur when the diapragm is irritated from blood loos in the peritoneum.

ECTOPIC PREGNANCIES MANIFESTATION 

Acute (or ruptured).with intraperitoneal hemorrhage  Acute pain ,and shoch ,and chronic(or unruptured),with less pain  No shock in either case  vaginal bleeding may be abseent.

ACTIVITIES NURSE 1. 2.

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The nurse should place her in trendelenbrug `s position . Inflat the pneumatic anthishock garment ,start two large –bore intraveneus (IV) lines and ringers laktat solution. Consider a tranfusion of negatif blood for severe cases that do not respond to the istration of cristalloids.

 Draw

blood for a complete blood cell count (CBC).  Determinition of sedimentation rate and typing and croos-matching for possible tranfusion.  In many largers institutions, it is now possible to determine pregnancy at early gestation with a blood sample for radioimmunoassay.

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Radiorereceptorassay, but for those institution withuot facilities to perfome this test, the urine is still used for pregnancytesting. It should be ed, howewer, that negativ urine test for human corionic gonadotropin (hCG) is not enterely reliable in rulling in out a ecopic pregnancy since not all ectopic pregnancy are estabillished enough to provide suficience level of hCG to give positive result.

 History

taking is again of utmost importantce for diferential diagnosis of septik shock  PID, or ectopic pregnancy, sudden onset of pain, sexual activity, missed or abnormal menstrual periods, and history of tubal infection or surgery, are especially indicative of ectopic pregnancy.  A normal sedimentation rate and absence of a fever shold rule out PID.  Pelvic radiographs are not helpful, but the pelvic ultrasonographic study and specific for ectopic pregnancy.  In this authors experence, women with ectopic pregnancys often state that they feel as if they need to help a bowel movement.

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Fifteen percent of patient with ectopic pregnancy, are simpthomatic before the first mised periods. In these cases the patient will not have mised a menstrual period and most likely doesnot know that she is pregnant. The patient need now preparation for ultrasonography, which gives a picture of pelvic structure, other than hidration so that the full blader can be used as a point reverence for the radiologies.

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still perfomed in many areas of the Unit State Couldosentesis (needle aspiration of the doglas col-de sac through the vagina) is not recommended since the procedure is not infillible. Aspiration of blood from the col-desac is diagnostic, for intra peritonial bleding, but absence of blood does not rule uot ectopic pregnancy The use laparoscopy as a save and efective diagnostic toolis the usually cols of action

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Is a tubal pregnancy is pound salphingektomy is perfomed , laparoscopy infoulves giving a general anastation and making small incicion (a proximaly 1to 2 inches wide) at umbilicus trough which a slender tube containing a telescope lens is spases in to the peritonial cavity.  This lens permints the ginecologis to examined the ovaries, falopian tubes and the outside of the uterus without subjecting to the trauma of the explaratory laparotomy and prolonged hospital stay.  The patient can usually be discharge as soon as she recoveresfrom anasthation. IF not condition recuiring surgery is fond.

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If the patient is in shock, the nurse shuld stabilished the condition with fluid or blood replacement as indication ister of oxygen. If blood loss is suficience to cause respiratory difficulties, and transfer the patient the operating room if indicated. The nurse must also recognize the patient and family for emotional . The patient may have fearly not only for her live but for her foture feel boring ability